Nelson Emerges As Seniors' Champion

Senator Fights To Keep Medicare Provisions

Florida Sen. Bill Nelson is trying to become the political champion of senior citizens on health reform as he and fellow Democrats struggle to prevent a backlash from older voters.

Nelson persuaded the Senate Finance Committee last week to shelter senior citizens from a tax hike designed to help pay for reforms. And he added a measure to the committee bill to allow patients in many Medicare Advantage plans to retain low-cost coverage, plus fringes such as vision, dental care and health-club memberships.

Much like his mentor Claude Pepper, Nelson is being hailed for protecting the elderly but faces the scorn of budget hawks who say Congress protects the old at the expense of the young.

This role serves Nelson back home, where many senior citizens are seething about legislation they fear will take away precious benefits, especially under plans run by health maintenance organizations.

"They are fabulous plans. We seniors just love them, and we're scared stiff that we are going to lose them," said Arnold Ruskin, 74, of Margate, who is second-guessing his vote for President Barack Obama. "If they let this thing go through, all those Democratic congressmen we voted for are going to be out of a job, because we're going to vote Republican."

Polls consistently show that older voters are generally happy with Medicare, fear changes and are much more opposed than younger Americans to the legislation working its way through Congress.

Many don't believe claims from Obama and Democratic leaders that the government can cut $560 billion from Medicare over 10 years without pinching their benefits.

Nor do many accept the argument that reduced spending on Medicare Advantage plans would force HMOs to operate more efficiently without giving up the added benefits, such as low co-payments and deductibles, that make them popular.

More than a fourth of Medicare patients in Florida have joined these plans. There's even higher participation in South Florida, where 49 percent take part in Miami-Dade County, 45 percent in Broward County and 31 percent in Palm Beach County.

"It's beyond understanding what they are doing," said Sam Berenstein, 80, of Hollywood. "How can you support a health plan that removes $500 billion from Medicare? If it is possible, why didn't they do it last year? Prove it to me."

Sponsors of proposed reforms point to estimates that Medicare Advantage plans - which pay a set monthly rate to HMOs per patient - cost on average 14 percent more than fee-for-service reimbursements to doctors.

Nelson voted against the bill establishing these plans and still calls the arrangement "severely flawed." But he contends it would be unfair to take away benefits from those who have them under current law.

The Senate Finance Committee on Thursday accepted a modified version of a Nelson amendment designed to retain benefits for those already enrolled in Medicare Advantage plans.

Nelson also pushed through an amendment to spare senior citizens from a tax hike, which would raise the threshold for deducting personal medical expenses from 7.5 percent to 10 percent of annual income. The government would make up the difference in revenue by not allowing employers who don't offer insurance to their workers to claim the penalty as a business-tax deduction.

Budget hawks wonder whether attempts to protect the elderly will end up costing taxpayers or leaving a bigger debt for younger generations.

"Seniors are getting a good deal from the government for health care. They get a greater share of benefits at the expense of other groups," said Joshua Gordon, policy director of The Concord Coalition, a nonpartisan watchdog group that opposes deficit spending. "Whether it's fair is in the eye of the beholder. What's clear is that we're going with the group with the most political heft, and right now that's senior citizens."

Nelson, noncommittal for months on health care controversies, has emerged as an aggressive promoter of senior citizens causes.

"He's gotten out front on this, and he's getting a lot of good attention back home," noted Susan MacManus, an expert on senior citizen voters at the University of South Florida.

In a speech on the Senate floor, Nelson said he is fulfilling a mission handed down by the late Pepper, a former Florida senator and congressman, who became famous in the 1980s as a champion for senior citizens across the country.

Nelson recalled the advice Pepper gave him many years ago: " 'Bill, I want you to look out for our seniors. Someone has to look out for them.' "

William E. Gibson can be reached at wgibson@SunSentinel.com or 202-824-8256.